May 19, 2009

  • regulating health care


    I think it's a little scary when I, a tiny little person tucked away in the woods, am more educated about a particular problem than a huge insurance company and a huge pharmacy retail chain combined.
    Got a call back this morning from another insurance rep who is in on the changing coverage policies.  She knows ~nothing~ about the drugs.  I had to help her pronounce chlordiazepoxide and tell her what it's for (in combo with clidinium, which are the librax pills).  She didn't sound dumb or anything, probably more like overwhelmed with so much medi-speak and stacks of technobabble in all their policy documents.  She tried to tell me that my med was "dezzy coded" by the FDA as an older drug (basically something they haven't been able to control from the beginning, like new drugs awaiting approval, but she didn't say that), but she noticed that even though the 2.5 isn't covered on my generic, the 5.14 is, and she's assuming those are dosages.  She told me that the refill on 3-20 was coded 5ng-2 and it went through fine, but had no idea why, and couldn't see the difference in why a different code would cut off my coverage.  I told her thanx for her time, I'd speak to the pharmacist about it.
    The pharmacist says those are manufacturing codes.  The 5ng-2 was manufactured by Breckenridge, the 2.5 is from Excellium.  (This generic has rotated around manufacturers like a hot potato the last few years since the FDA has targeted any facility that makes it [along with many other generics they can't control], effectively shutting them down and initiating recalls, even though there have been NO consumer complaints.)  I gave the 800 # connecting straight back to this last rep (without the horrible automated menu and regular runaround) to the pharmacist, who was very concerned about the insurance company not understanding the manufacturing codes.  I have a feeling *someone* understands them, and I'll even bet might be receiving perks under the table from the FDA for helping them target these companies, who, in the long run, seem to be folding and going out of business one after another like dominoes.  In short, the FDA seems to be driving generics they can't control completely off the table.  Doctors are upset, pharmacists are upset, patients are upset, and no one seems to know what the heck is going on, and communication is so garbled and blocked between everyone that it took a very persistent person with a miserable illness and plenty of time on her hands (moi) to keep calling, and calling, and calling...
    You wanna know what's going on out there?  EDUCATE YOURSELVES.  CALL PEOPLE.  I have spent hours studying anything I can find on this stuff on the internet (I know the molecular structure of my meds- do you?) and contacting people who are supposed to be helping me cope with my illness challenges.  Your doctor's hands are tied, your local pharmacy's hands are tied, and the looming shadow over us deciding who gets treatment is the Food and Drug Administration.  If your insurance company stops paying for your medication and the med is NOT pulled off the market for any reason to save lives, chances are your insurance company is nervous about something.  Like the Feds regulating the crap outa everyone and threatening their bookwork with a big ol' government audit.  There are some people out there standing up with the idea that the FDA actually oversteps Constitutional rights with their seemingly unstoppable agenda to walk in and start taking over for no better reason than they are trying to gain more control, not caring how many people they make miserable doing it.  The whole Lotronex mess happened because the FDA approved it, 8 people out of 150,000 died, it got recalled pending a class action lawsuit (Aren't those fun?  You get enough people jumping on, you get a 50 cent compensation check and the law firm makes millions), and a few years later, it's back on the market, and a hundred thousand people are going 'Oh, thank God', writing on message boards in great detail how miserable their lives have been without it.  Meanwhile, Librax (the medication I take) has been around for over 2 decades, millions of dosages have been administered, there's no class action lawsuit or anyone out there really complaining about it, it's personally kept me out of the hospital on several occasions, and the FDA has been working on making it more and more difficult to get hold of for several years, as per the abstract quote in my last post.
    The pharmacist is going to try to talk to this last insurance rep this afternoon.  I don't know if she'll 'get anywhere', since neither one is in a position to change policy, but the *important* thing is that they are getting together with real information.  The secret to this whole mess is LACK OF CRUCIAL INFORMATION between big corporations, between retailers and consumers, between insurance reps and clients, and especially between the FDA and ALL of us.
    I'll update on this again if I get new info.  I can't repeat enough in my 'Not to 50!' posts-- YOU are in charge of your health, and YOU need to educate yourself as much as possible about your illnesses and medications.  Sitting back and whining about any of it isn't cool, and only allows more and more people to control everything that winds up making you miserable.  Don't be afraid of new words, technical info, things you don't understand.  It'll soak in, the dots will start connecting, and before you know it, you wind up smarter than the doctor about your medication and how it works in your body, smarter than the insurance company about the politics of coverage, smarter than the pharmacists about how coverage works.  In this day and age, people are overworked and overwhelmed with way too much information, and YOU just might be that link in their lives that makes it all make sense.
    Our new administration has made comments about patients being 'cost effective', worth the treatment they get.  It's not been pretty to think that life is no longer sacred, that 'sickies' might get 'weeded out', that our place on this earth is no longer a God-given right under the Constitution.  Well, Mr. Obama, Mr. Daschle, and whoever else is listening-- just because I'm stuck at home now with illness does NOT mean I'm more worthless as a human being.  Having spent 20 years living with and observing my illness, having spent countless hours a week studying how to survive and live under this much duress, how to make my own decisions about my quality of life, damn betcha I'm 'cost effective'.  Oh, HELL yeah.
    And all the rest of us can be, too.  The question is-- Who makes the world a better place?  We the People, or some big government telling us what medications we can't take?  I sit back and laugh.  It comes back around to bite.  We ALL get older, we ALL get health problems sooner or later.  The workaholics with 6-figure salaries in their fancy corporations and big houses and cars-- it's coming.  Death.  Disability.  Age.  You can't 'regulate' health.  Sorry, guys.

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Apologies for the missing vids, another upgrade during the server migration swept through like a scan sweeping through the Enterprise. I'll fix those later, kinda busy...

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